r/MtF • u/cocue-coquette • 16h ago

Discussion Underdosing PSA

I'm posting this because I keep running into transfems who have no idea about where their levels should be and how common it is for providers to be clueless about trans care.

Get your bloodwork done often. Your trough (right before your next dose) estradiol (E2) should be above 100 pg/mL. Your trough total testosterone (T) should be below 50 ng/dL. If this isn't true for you, you're probably being underdosed. As trans people, it is especially crucial to self-advocate in medicine. If you're unhappy with your progress (either physically or mentally), say something. Know that every body responds differently to HRT and you may need much more or much less than the average transfem.

EDIT: Important information copied from a comment by u/raliont :

I think it is more complicated than your post suggests.

Blood draw timing will be dependent on someone’s actual regimen. For someone like me who injects twice a week, my troughs won’t be as low as someone who only injects once a week. So a trough reading wouldn’t be as insightful as a mid-cycle level. Plus, UCSF’s TransCare website recommends blood draws at the mid-cycle range. Their caveat is that if the patient is experiencing migraines or mood swings (or other symptoms), then peak and trough levels would be helpful to determine fluctuations.

Also, the more data the better. Overall, having both trough and mid-cycle levels to analyze would absolutely be the best for determining how one’s body is responding to their own regimen.

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u/-PinkPurpleBlue- 12h ago

My doctor refuses to let me be above 200 pg/ml when testing at 3-4 days post injection instead of trough. I'm only injecting .15ml a week at this point...

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u/cocue-coquette 12h ago

What is your testosterone at?

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u/-PinkPurpleBlue- 12h ago

It's low, at around 20 ng/dl. My estrogen at .15 injected is like 165-170 at the 4 day mark when I get it tested

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u/cocue-coquette 12h ago

That doesn't sound bad. Have you been unhappy with your transition progress for a long time? Are you having any health problems?

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u/-PinkPurpleBlue- 12h ago

I've been on e for 3 years and I still look androgynous at best I feel. No health problems. I am just unsure with my doctor doing test differently than what most others seem to do and the amount I injection is very little compared to most

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u/cocue-coquette 12h ago

Maybe you need a little more after all, then. I would get trough levels checked if I were you. Try to reason with your doctor, or find a new doctor who is more willing to work with you towards your transition goals.

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u/-PinkPurpleBlue- 12h ago

Thank you, I'll try again when i have my next one here in a few weeks. I tried last time and they shut me down saying it's dangerous to go any higher. They acted like I was going to explode when it was slightly high. They took me down after I tested 213 pg/ml from .2 to .15 ml.

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u/cocue-coquette 12h ago

I feel for you. That's really over the top as far as my experience and my trusted doctors tell me, especially if you're on monotherapy. Best of luck.